Hawaii stands to lose millions if ACA is repealed

Justice Amy Coney Bartlett’s recent appointment shifted the U.S. Supreme Court further into conservative territory and many fear the Affordable Health Care Act is now at risk. If the ACA is repealed, Hawaii could lose $400 million and 86,000 Hawaii residents could lose their health care.


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In a speech to Congress last week, Sen. Mazie K. Hirono (Hawaii) urged the U.S. Senate to reject the nomination of Barrett.

“In a little over two weeks, the Supreme Court will hear oral arguments in California v. Texas – a lawsuit where the Trump administration and 18 Republican State Attorneys General are asking the Court to invalidate the Affordable Care Act – like Justice Scalia voted to do in two earlier cases,” she said. “My Republican colleagues know they can count on (Barrett) to provide the decisive 5th vote on the Supreme Court to strike down the ACA – to help them win through the courts an outcome they tried and failed to achieve 70 times — 70 times — in Congress. The consequences of Judge Barrett’s vote to strike down the ACA would be catastrophic.”

The Economic Policy Institute predicts 29.8 million people nationwide will lose their health insurance if the Affordable Care Act (ACA) is repealed and another 1.2 million jobs will be lost. Hawaii’s number of uninsured people would jump by 99% and 4,299 jobs would be lost, or 7 out of every 1,000. That would increase the unemployment rate by .7%.

The ACA put an end to lifetime limits which affected 462,000 Hawaiians with employer or individual market plans. It allows for an estimated 9,000 young adults under the age of 26 to stay on their parents’ health insurance, and it provides free preventative care, such as flu shots, cancer screenings, contraception and mammograms, to an estimated 631,000 Hawaii residents.

The act expands the eligibility of Medicaid and allowed for an estimated 33,000 Hawaiians to have health coverage. That equates to 4,000 more Hawaiians having access to care, financial security and health care and means 4,700 fewer Hawaiians are struggling to pay medical bills and 40 deaths are avoided each year.

It also expands coverage for Hawaiians with mental illness or substance abuse disorders and, as a result, 3,000 fewer Hawaiians are experiencing depression. The act is saving Hawaii millions in uncompensated care costs. Rather than spending $40 million on uncompensated care, Hawaii gets $280 million in federal support to provide low-income adults.

During open enrollment for the 2020 coverage, 20,073 people enrolled in private plans through Hawaii’s exchange. That was a slight decrease from the 20,193 that enrolled for 2019 coverage. Hawaii is one of the few states that saw an increase in enrollment every year from 2014 to 2019.

In an effort to preserve parts of the Affordable Care Act despite federal actions, Hawaii state legislators passed SB2340 in July 2018 that extends dependent coverage for adult children up to 26 years of age, prohibits health care entities from imposing a pre-existing condition exclusions and prohibits health insurance entities from using gender to determine premiums or contributions. However, though short-term plans are limited, there is no reinsurance program.

Hawaii had a low uninsured rate prior to the passage of the Affordable Care Act, thanks to the Hawaii Prepaid Health Care Act which was enacted in 1974. The act requires employers to provide health insurance to employees who work more than 20 hours a week and to pay up to 50% of their premiums. Affordability is defined as 1.5 percent of income, as opposed to the 9.78 percent of income under the ACA.

Due to its small population of uninsured, a poorly functioning website and small population, the exchange in Hawaii costs $23,899 per enrollee, which was the most expense state rate in 2014.